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Published on: June 12, 2021
Modified shock index is a predictor for 7-day outcomes in patients with STEMI
Qing Shangguan1, Jing-Song Xu1, Hai Su1
1Department of Cardiology, Second Affiliated Hospital of Nanchang University.
Insights
Modified shock index (MSI) and shock index (SI) both predict outcomes in ST-segment elevation myocardial infarction (STEMI) patients. MSI demonstrated higher accuracy in predicting 7-day major adverse cardiac events and mortality.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring rapid risk stratification.
- Early identification of patients at high risk for adverse outcomes is essential for timely intervention.
Purpose of the Study:
- To compare the predictive capabilities of the modified shock index (MSI) and the traditional shock index (SI) for 7-day outcomes in STEMI patients.
- To evaluate the accuracy of MSI and SI in predicting major adverse cardiac events (MACE) and all-cause mortality.
Main Methods:
- A retrospective study of 160 STEMI patients undergoing emergency percutaneous coronary intervention.
- Calculation of SI (Heart Rate/Systolic Blood Pressure) and MSI (Heart Rate/Mean Arterial Pressure) using emergency department vital signs.
- Assessment of 7-day MACE, including all-cause mortality, life-threatening arrhythmias, cardiogenic shock, and Killip class.
Main Results:
- Increased MSI (≥1.4) and SI (≥0.7) were associated with higher MACE rates.
- MSI showed significantly higher odds ratios for predicting all-cause mortality, cardiogenic shock, life-threatening arrhythmias, and overall MACE compared to SI.
- Both MSI and SI were identified as independent predictors of MACE, with MSI exhibiting a higher odds ratio (3.05 vs. 1.07).
Conclusions:
- Both SI and MSI are valuable tools for predicting 7-day mortality and MACE in STEMI patients presenting to the emergency department.
- MSI appears to be a more accurate predictor of adverse outcomes than SI in this patient population.
Subject:
The aim of this study was to compare the predictive values of modified shock index (MSI) and shock index (SI) for 7-day outcome in patients with ST-segment elevation myocardial infarction (STEMI).
Methods:
This retrospective study included 160 consecutive patients with STEMI and emergency percutaneous coronary intervention. The blood pressure (BP) and heart rate (HR) measured at emergency department were used to calculate SI (HR/systolic BP) and MSI (HR/mean artery pressure). The major adverse cardiac events (MACE) included all-cause mortality, life-threatening arrhythmias, cardiogenic shock, and Killip class within 7 days.
Results:
Forty-nine patients had increased MSI (≥1.4), whereas 72 had increased SI (≥0.7). Except the parameters on BP and HR, other parameters were similar between the normal and increased SI groups. However, the increased MSI group had significantly higher age (69.0 ± 13.0 years vs 63.9 ± 12.9 years, P = .025) than the normal MSI group. The 7-day all-cause mortality was 8.8%, and MACE rate was 24.4% in this study. Both increased SI and increased MSI predicted higher MACE rates. However, the odds ratios of increased MSI for all-cause mortality (6.8 vs 3.4), cardiogenic shock (3.0 vs 1.6), life-threatening arrhythmias (9.1 vs 4.6), and MACE (6.8 vs 3.4) were higher than those of increased SI. Modified shock index and SI were independent factor for MACE, but the odds ratio of MSI was higher than of SI (3.05 vs 1.07).
Conclusions:
Both SI and MSI in emergency department could predict the all-cause mortality and MACE rates within 7 days in patients with STEMI, but MSI may be more accurate than SI.
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